Académique Documents
Professionnel Documents
Culture Documents
TREATMENT
OF
A. 0. BADIB,
By
M.D.,t
CANCER
S. S. KUROHARA,
and
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OF
M.D.,
nasal
usually
reported
sis.37b0
Most
dude
malignant
tumors
are relatively
rare
cavity
these
tumors
to
of
and
The
as benign
the
Roswell
prognostic
on
discussed
with
the
the
experiences
in
the
tum,
cancer
of the
of different
results
and/or
an
re-
of pa-
Institute
of patients
with
The
influence
factors
the
compared
in selection
Memorial
irradiation
radiation
and
easily
we present
Park
management
nasal
cavity.
not
in
literature,
or
defined
difference
of
treat-
surgery
will
be
tive
the
January,
period
of
23
years,
1942,
weeks
to more
ing
8 months.
(Table
Radiation
years,
common
were
i)
(77
the
than
The
per
the
unilateral
cent),
Therapy
vestibule,
No
factors,
atrophic
nasal
Department,t
node
rhinitis
such
or pre-
Head
ob-
and
and
floor.
in
19
cases
(3,
per
cent).
metastases
were
distant
found
in
metastases
8 cases
in
(.
(14
cases
Roentgenologic
examination
of the nose
and nasal sinuses showed
bone destruction
in 18 cases,
nasal
opacity
or mass
in 14
cases,
and both in I I cases.
Ethmoidal
and
maxillary
sinusitis
was
seen
in 10 cases
(Table i).
To assess
the importance
of the extent of
tumor
as a prognostic
factor,
a clinical
staging
was devised
(Table
III),
based
on
TNM
classification
used by Cocchi.
Stage
discharge
and
choana
410
cases
showed
extension
outside
cavity,
mainly
to the maxillary
(9
cases),
ethmoidal
sinuses
and nasopharynx
( cases). Lymph
per cent)
and
(4 per cent).
average
beearly
sympnasal
posterior
lesions
antrum
cases),
between
and December,
1964,
a total of 57 patients
with malignant
tumors
of
the nasal
fossa
were
treated
at Roswell
Park
Memorial
Institute,
Buffalo,
New
York.
The clinical
features
in the series
are
presented
in Table
i.
Males
were
more
frequently
afflicted
than females.
The average age incidence
was 6i years
and 77 per
cent
of the
cases were
above
50 years
of age.
The
duration
of
symptoms
varied
from
* From
cent).
9 on the
tubinates
(2-upper,
and 3-lower
turbinate)
and
Eighteen
the nasal
MATERIAL
toms
pre-
5 per
(i
site of origin
could
not be determined
in 10 cases
with
cancer
filling
the entire
nasal
cavity
(Table
II).
These
tumors
were
either
polypoidal
masses
in 38 cases
(67 per cent)
or ulcera-
evaluation
of the indicaand
results of radiation
techniques
struction
polyps
nasal
in 8 cases
predisposing
growths,
and
The
therapy.
Over
and
frequent
study,
clearly
of the
for
for
the tumor
potential
less
on
wall.
Other
sites,
in
frequency
were:
sep-
not
the
surgery
are
by
ceded
other
of diagof
were
I)
cent),
and
remaining
reviewing
for
of treatment
In this
other
cancer
(Table
per
The
(40
middle,
In
are
tients
tion
of
epistaxis
per
cent).
(28
usually
late.
Chronic
sinusitis
si-
problems
cent),
treatment.
indications
ment
special
per
irradiation,
were found.
tumors
were limited
to the right side
nasal cavity
in 33 cases
(8
per cent),
left side in 2! cases
(,7 per cent),
and
bilateral
in 3 cases
( per cent). The
wall was the most
frequent
site of
desirable.1
because
with
paranasal
C.M.,t
YORK
(54
in-
M.D.,
vious
The
ofthe
to the
were
lateral
tumor:
the
sults
group
J. H. WEBSTER,
local
pain
symptoms
prognoreports
CAVITY*
M.D4
NEW
the
are
tion
therapy
poor
the
management
nasal
fossae6
the prognosis
at
in one
of
nuses.35-8#{176}4
published
tumors
mainly
nosis
have
the
of
and
NASAL
PH.D.,t
D. P. SHEDD,
BUFFALO,
P RIMARY
THE
1969
Neck
York.
824
Department,
RoSwell
Park
Memorial
Institute,
Buffalo,
New
VOL.
106,
Treatment
No.
of Cancer
(T1_T2,
N0, M0) included
i6 cases;
Stage
II (T1_T2,
N1, M0),
6 cases;
Stage
III (T1_T,,
N2, or T,, NO-N2),
17
cases;
and Stage
iv
(T4, N,-N2
or T1-T4,
M), 18 cases.
T1 denotes a tumor
limited
to the mucosa
that is
I
cm.
in diameter
or less;
T2, mucosal
lesion
more
than
i
cm.
in diameter;
T,
tumors
involving
bone
or cartilage;
and
T4, extension
outside
the nose. N1 means
a
mobile,
unilateral
lymph
node;
and
N2
fixed
or bilateral
lymph
nodes.
M stands
for distant
metastases.
The diagnosis
was established
histologically in all the cases and is given
in Table
II.
The
predominant
type
was squamous
cell carcinoma
(I 2-well
differentiated,
medium
differentiated,
and
8-undifferentiated,
while
8 were ungraded).
This was
followed
by adenocarcinoma
(i i
cases),
mixed
salivary
tumor
( cases), anaplastic
carcinoma
(.
cases)
and malignant
melanoma
(2 cases).
of the
Nasal
825
Cavity
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CLINICAL
Age
Under
surgery
and
(13
irradiation
cases);
(14
and
cases)
combined
(Table
were
(30
12
21
45
79
40
5
8
60-69
70-79
8o
Symptom
years
13
23
4
Duration
17
2-4
34
30
25
Over
14
JO
17
14
12 months
Presenting
Symptom
obstruction
44
Nasal discharge
Epistaxis
Local pain
31
77
54
23
40
i6
28
Nasal
32
2!
swelling
Epiphora
Visual disturbances
Neck mass
Tumor
Extension
Maxillary
antrum
Ethmoid
sinus
Orbit
Nasopharynx
Sphenoid
sinus
Cribriform
plate
Lymph
Distant
Bone
by
2.
16
7
5
4
2.
14
Findings
opacity
or mass
Both
Chronic
Negative
9
5
destruction
Nasal
5
3
nodes
metastases
Roentgenologic
eye
39
0-2
6-12
III).
12
22
2
46
surgery
9
4
50-59
used
cases);
In the irradiation
group,
25 cases
(#{231}
per
cent)
received
external
radiotherapy
alone,
10
cases
had radium
therapy
alone
and 9
cases were
given
external
irradiation
plus
radium.
Tumors
of the
vestibule
were
treated
by a single
field using orthovoltage
radiation.
Single
anterior
fields
were
used
for irradiating
other
tumors
in the anterior
part
of the nasal
cavity.
Parallel
opposing
fields was the technique
employed
in lesions
of the posterior
choana
while
anterior
and
lateral
wedge
pair was used in some tumors
involving
the
maxillary
and
ethmoidal
sinuses.
In extensive
lesions,
three
crossfiring fields were preferred. Orthovoltage,
supervoltage
and cobalt 6o equipment
were
used and the tumor
dose was in the range
of
5,000
to 6,ooo rads in 5-6 weeks
depending
on the volume treated. In some
cases,
it was
necessary to include the ipsilateral eye in
the treatment
field, protecting
the other
Patients
40-49
Over
Per Cent of
Patients
Sex
Female
Male
TREATMENT
series,
three
modalities
treatment:
irradiation
FEATURES
No. of
Nasal
In this
as initial
TABLE
sinusitis
i8
32
14
25
II
19
30
17
lead
or
by
tilting
the
beam
of
the
lateral fields.
Intracavitary
and
nasal
fossa
interstitial
radium
limited
to
Radium
appli_
in small tumors
(io
cases).
826
0.
A.
Badib,
J.
S. S. Kurohara,
H. Webster
BY ANATOMIC
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Nasal
Lateral
Wait
Septum
32
D.
P. Shedd
AUGUsT,
II
TABLE
PATHOLOGY
and
S1FES
Sites
Yes-
Total
Choana
.
tiDuie
Undeter.
mined
Floor
No.
Per
Cent
Squamous
carcinoma
Anaplastic
carcinoma
2.
8
3
II
19
39
i6
10
28
12
3
5
33
i8
Lymphoepithelial
Adenocarcinoma
Mixed salivary
Malignant
carcinoma
tumor
melanoma
Total Number
Per Cent
cators
cavity
or molds
through
lesions
were
inserted
the
nostril
or through
a nasal
catheter
part.
Partial
necessary
posterior
for lesions
excision
of
in some
application.
radon
seeds
the
into
for
cases
the nasal
anterior
naris
tumors
of
the
and
In
treated
by
radium,
cases
External
radium
anterior
o.
the
TREATMENT
cm.
from
57
in
tumor
exten-
procedures
external
dose
intracavitary
to add
the surface
7-8
intracavitary
oflocally
Following
iii).
100
rads
size.
plus
in 9 cases
an
applied
surgical
of
5,000
radium
rads
applications.
3,000
in 4-6
used
in 25
cases
III
BY CLINICAL
II
x6
weeks,
was
The
Clinical
All Series
irradiation
used
(Table
100
6,ooo-7,ooo
upon
tumor
to
rads/5
applicator
TABLE
was
radiotherapy
septum
INITIAL
dose
depending
radium
was
sive
tumor
radium
needles
or
in 4 patients
with
accessible
floor.
using
in the posterior
the
tumor
was
to facilitate
Interstitial
were
used
tumor
days
32
STAGES
Stages
Total
III
IV
No.
Per
17
18
57
Cent
100
Treatment
Irradiation
Irradiation
External
Radium
Combined
Techniques
irradiation
Surgical
Procedures
Local resection
Radical
Combined
Preoperative
with
30
53
13
23
3
6
14
24
2.
II
Surgery
Combined
Surgery
irradiation
Postoperative irradiation
25
57
10
23
20
6
3
14
52
13
48
29
10
7!
II
at
VOL.
io6,
Treatment
No.
of Cancer
of the
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OF
TREATMENT
BY
Cavity
827
IV
TABLE
RESULTS
Nasal
CLINICAL
STAGES,
5 YEAR
CRUDE
SURVIVAL
A.
Clinical
Stages
HISTOLOGY
AND
SITES
Total
Stage
Stage
Irradiation
8/9
(89%)
1/2
Surgery
4/5
(8o%)
2/3
Combined
Total
4/6
.
Anaplastic
Carcinoma
Carcinoma
Irradiation
Surgery
Combined
Total
#{149}th1
epi
Stage
i/6
(17%)
0/I
( o%)
8/12
(67%)
2/4
(50%)
2/5
(o%)
/io
(o%)
6/13(46%)
Adeno-
e ia
carcinoma
Carcinoma
1/3
(%)
2/2
1/2
(o%)
2/3
3/5
(60%)
2/4
(o%)
4/9
(44%)
34/24
(6%)
1/4
2/2
(25%)
(100%)
2/2
(100%)
C.
Maiignant
Salivary
(25%)
Melanoma
(100%)
12/23
(67%)
4/5
Total
iviixed
i/
(52%)
Histology
(73%)
(o%)
12/23
3/12(25%)
5/7
6/12
IV
(%)
(67%)
(67%)
Lympho-.
III
2/3
2/6
(100%)
B.
Squamous
Stage
(o%)
(67%)
I/I
12/14(86%)
II
(8o%)
o/i
(0%)
0/I
(o%)
(52%)
8/12
(67%)
/io
(o%)
Site
Total
Lateral
Wall
Septum
Vestibule
Choana
Undetermined
Irradiation
Surgery
Combined
3/6
3/5
(o%)
3/6
(o%)
2/3
(67%)
(6o%)
4/5
(8o%)
1/2
(o%)
2/3
(67%)
1/2
(50%)
i/i
(100%)
1/4
(25%)
Total
8/14
(#{231}%)
8/13
(62%)
4/6
(67%)
2/3
(67%)
3/9
(%)
or
tology
and
sites
14
cancer
in
this
series
were
electrocoagulation
simple
of
small
resection
tumors
in
cases,
and
radical
resection
of the nasal
cavity
and maxilla
with
curettage
of the
ethmoidal
and
sphenoidal
sinuses
in the
more extensive
tumors
in 13 patients.
Orbital excision
was done in 2 cases
and radical
neck dissection
in 4 cases.
In the combined
radiotherapeutic
and
surgical
treatment
preoperative
irradiation
was given
in 4 cases and postoperative
irradiation
in io cases
using
radium
or external
radiation
therapy.
The dose and the
technique
depended
on the volume
of tissue
irradiated
and were
similar
to those
described
above.
RESULTS
Table
iv illustrates
ment
in the various
the results
of treatclinical
stages,
his-
2/3
(67%)
2/5
(40%)
32/23
limited
of tumors.
to
the
Early
nasal
(52%)
8/12
/io
(67%)
(50%)
stages
mucosa
of
ex-
hibited
the best
prognosis.
Figure
and
Table
Iv
show
that
well
differentiated
squamous
cell carcinomas
had the best results and that adenocarcinomas
had better
prognosis
than
undifferentiated
squamous
cell and anaplastic
carcinomas.
Other
histologic
groups
exhibiting
good results
were
the lymphoepitheliomas
and mixed
salivary
tumors.
The whole series had a crude
year
survival
rate of 56 per cent,
and a higher
tumor-free
actuarial
survival
rate
of 67
per cent due to the fact that
some
of the
patients
were
free of tumor
at death
or
follow-up.
In the cases with early
stages
of this tumor (Stage
and II combined)
treated
by
irradiation
or surgery,
year
survivals
of
82 and
75 per cent,
respectively,
were ob-
A. 0.
828
Badib,
S. S. Kurohara,
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J.
H.
Webster
and
D.
P. Shedd
AUGUST,
1969
lowed
radiation
treatment,
while
3 recurrences
appeared
after
surgery,
and
after
the combined
treatment.
All the persistent
and recurrent
lesions
occurred
in the patients
with
an initial
advanced
tumor
of
Stages
HI
and Iv. Recurrences
after
initial
surgical
or combined
surgery
and
irradiation
were
treated
by irradiation.
Four
of
the persistent
and recurrent
tumors
following initial
irradiation
were re-irradiated
and
the
remaining
5 received
surgical
treatment.
The
final
assessment
of tumor
status
showed
year cure in 40 cases and failure
in 17 cases.
The failures
include
9 patients
with local tumor,
4 with metastases,
i with
both,
and 3 of unknown
status.
>
DISCUSSION
The concepts
of treatment
of nasal
candiffer
in the various
published
studies
and change
from time
to time in the same
clinic.39
Irradiation,
alone,
was the pricer
mary
method
while
treatment
10
YEARS
FIG.
Survival
of the
rate
nasal
cavity.
tumor-free
cases,
groups
cent
cinoma,
AFTER
curves
survival.
the
interrupted
and
the
confidence
ungraded.
DIAGNOSIS
after
diagnosis
Crude
(ii)
The
I, II
and
curve
is
(B)
for all
is for the
histologic
represent
95 per
vertical
bars
interval.
SC = squamous
SC I, II and III
cell carcinoma,
Grades
anaplastic
carcinoma.
of cancer
survival
solid
curve
and
of treatment
combined
III.
cell carsquamous
Anapl.=
tamed
(Table
iv). In late stages
(Stage
iii
and Iv combined)
which
received
radiation,
surgical
and
combined
treatments,
the
year
survivals
were:
25, 50, and
per cent,
respectively.
Sixteen
cases
(28
per cent)
showed
either
failure
of response
(4 cases)
or recurrences
(i 2 cases)
after
the initial
treatment.
Four of the recurrent
cases developed
regional
lymph
node
metastases
and 2 of them
distant
metastases.
Eighty
per cent of the recurrences
appeared
within
the first year after treatment.
The mean
recurrence
time
was 10 months.
The
persistent
cases
and
of the recurrences
fol-
was
Treatment
series,59
and
advocated
others.35#{176}25
surgical
in some
cal
in some
radiation
surgical
in
was
many
essentially
clinics367
and either
radiotherapeutic,
depending
or
radiosensitivity
others.48
ported
and
The
results
wide
can
ner in which
the
cases for treatment
sequent
extent
of
surgion the
tumor,
variations
in
be ascribed
to
in
the
the
reman-
various
authors
selected
and to the type of sub-
analysis.
The
treatment
methods
used
in this
series
depended
on the site, extent
and the
histology
of tumor.
Radiation
therapy
was
the most commonly
used technique
in both
early
and
advanced
tumors
including
many
epidermoid
carcinomas
and
adenocarcinomas
and all anaplastic
and lymphoepithe..
hal
carcinomas.
Surgery
was
used
principally
in some of the early cases and in tumors
with
bone and cartilage
involvement
and
in
cluding
carcinomas
Combined
vanced
a few locally
extensive
squamous
cell carcinomas,
tumors,
and
mixed
salivary
treatment
was
selected
lesions
of any
histologic
inadeno-
tumors.
in adgroup.
VOL.
io6,
In the
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apy
Treatment
No.
radiation
was
of Cancer
treatment,
selected
radium
for
small
ther-
accessible
lesions;
external
radiotherapy
for larger
and
less accessible
tumors;
and
radium
plus
external
irradiation
in more
extensive
dis-.
ease.
External
irradiation
was
commonly
used
as
it is more
Parker
apy
in
all
his
achieve
and
external
cases.
radiotherapy
al.2 in nasal
Radium
a homogeneous
However,
6o radiation,
tumor
dose
viously
without
the
Minor
depended
Devine
cancer
lethal
et
to
tumor
and
a radical
complications
pre-
conventional
early
and
surgery
by Oliver,0
radio-
late
radiation
plus
irradiation
while
more
ag-
procedures
and
on
therexternal
reported
in some of the cases
complications
were
seen
in
surgical
by Frazell
tion ofsimple
by
high
after
sequelae
were
but no major
this series.
Conservative
was advocated
gressive
plus
using
supervoltage
we can deliver
reported
therapy.3
satisfactory.
roentgen
was preferred
and
ethmoidal
dose.
cobalt
have
Lewis.3
or radical
the
In our
surgical
site
and
been
used
cases,
selecprocedures
extension
of
the
the
extent
histology
of involvement,
of tumors
are
important
found
results
struction.
Tumors
in
no
great
cases
In
this
difference
with
study,
or
between
without
the
cases
gion
may
and
base
deevi-
dent
bone
destruction
and extranasal
extension
had a shorter
survival
in all treatment
groups.
In cases with
tumors
limited
to the naval
cavity,
presence
or absence
of
roentgenologic
evidence
of bone
involvement
produced
no difference
in the results.
The
presence
of lymph
node
metastases
(relatively
uncommon
in this series,
14 per
and
to
the
posterior
the
skull,
choana
posterior
part
ethmoids,
while
of
spread
various
anatomic
Another
logic type.
MacComb
nosis
and
to
the
cer
sites.
Oliver0
to
showed
the
The
the
alter
type
of can-
prognosis.
survival
squamous
lowest
radiotherapy
be
considered
rate.
results
of
surgery
in many
publications
as criteria
for
in inoperable
or recurrent
tistical
difference
over-all
results
treatment
in
un-
carcinomas
versus
can not
comparing
their
respective
effectiveness,
as
was mainly
used
in early
operable
while
radiation
therapy
was limited
liation
residual
car-
The
anaplastic
survival
reported
rate
cell
in adenocarcinomas.
and
histoand
prog-
carcinomas
the
other
the
a higher
differentiated
than
On
that
appear
series
the
had
stated
not
the
nasophar-
the
undifferentiated
adenocarcinomas.
does
This
of
prognostic
factor
is the
Larsson
and Mrtensson,5
and Martin9
reported
bad
in
the
hand,
orbits
those
differentiated
bone
upper
extend
of
fac-
with
the
of
cinomas
the
829
Cavity
the nasal
region
were
reported
to have
a
poor
prognosis
due to their
early
infiltration.5
The influence
of a particular
site was
reported
to depend
on the ease with which
the tumor
can extend
to a surrounding
vital
structure;
e.g., tumors
of the
olfactory
re-
site
tors in determining
survival;
these
factors
will be discussed
before
the evaluation
of
the treatment
results.
Tumor
with
extension outside
the nasal
cavity
has a poor
prognosis.590
This is seen in the low survival rates
in the advanced
stages
of this Series. Roentgenologic
evidence
of bone
destruction
was
considered
an unfavorable
factor
in cancer
of the nose and paranasal
sinuses.0
However,
Larsson
and Martensson5
Nasal
in
tumor.
Because
and
flexible
advocated
of the
surgery
cases,
to pal-
advanced
tumors
disease.347
No
was
found
and
sta-
among
the
to
of the 3 main
methods
this
series.
However,
the
analysis
of the results
in each stage
showed
some
points
of interest.
In the early
mucosal lesions,
both
irradiation
and surgery
gave
equally
good results.
In tumors
with
bone or cartilage
involvement
or lymph
node
metastases
methods
Frazell
secondary
the
apparently
and
role
Lewis3
combined
and
yielded
better
using
irradiation
in residual
or
recurrent
surgical
results.
in a
tu-
A. 0. Badib,
830
mors,
reported
Downloaded from www.ajronline.org by 114.124.37.82 on 11/24/14 from IP address 114.124.37.82. Copyright ARRS. For personal use only; all rights reserved
irradiation
When
comparing
group
with
cent
per
in
rates
in
can
their
after
H. Webster
series
in
in the
detected.
radiotherapeutic
the
Also,
the
group
are
A. 0.
Roswell
in the advanced
8 cases
of nasal
by
surgery
the
series
of
patients
MacComb
survived
nasal
surgery
or
I.
with
combined
he
reported
years
all
after
the
67
radiation
tumors
Parker.
per
of the
In
1960,
2.
cent
fossa
patients,
control
external
using
i 2
rate
at
radiotherapy
in
cases
were
(30
cases),
irradiation
ation
small
therapy
accessible
in less
ternal
radiation
more
therapy
factory.
dures
or
and
extent
treatment,
The
radium
flexible
radical
the
in
in
and
surgical
according
of tumor.
surgery
was
irradiation
advanced
in
External
radiation
commonly
used
more
selected
the
site
combined
followed
treatment
of extension
squamous
of
The
series
was
radiotherapy
results.
invasion
In
and
the
9.
cent.
In the early
tumors,
surgery
gave
equally
good
or lymph
with
node
bone
or
metastases,
cartilage
LEFFALL,
paranasal
of 379
of nasal
Gynec.
&
G.
and nasal
cases
treated
Car-
cavities:
at Radium-
Department
radiol.,
L.,
cavity
and
1966,
112,
of
of
1954,
cavity.
OLIVER,
S.
I I.
67,
1957,
42,
Malignant
and paranasal
MED.,
SCHALL,
J.
AM.
8o,
L. Malignant
sinuses.
H. E. Cancer
of nasal
RD.
of
7.
neoplasms
of
sinuses:
evalTr. Am.
4cad.
&
ROENTGENOL.
R. G. Carcinoma
1958,
of nasal
592-604.
47, I 1-23.
ofnose
and paranasal
America,
1967,
47,
1942,
ROENTGENOL.,
SKOLNIK,
and WHITE,
J. E. Cancer
paranasal
sinuses.
Am.
436 -438.
therapy.
P Cancer
Clin.
North
PARKER,
F.,
J. Tumors
B.
radiation
THERAPY,
TO.
M.
SNITMAN,
SOBOROFF,
sinuses.
595-600.
fossa.
&
THERAPY
of
RAD.
J.
AM.
NUCLEAR
766-774.
tumors
7.I1.M.I1.,
of nose
I 948,
and
137,
nasal
I 273-
1276.
14.
Sooy,
F. A. Primary
tumors
of nasal
septum.
Laryngoscope,
1950,
60,
964-992.
WILLIE,
C. Malignant
tumors
in nose and its
accessory sinuses. Acta oto-laryng.,
1947,
Suppl.
6,
1-58.
:.
WINBORN,
33.
sinuses.
-
F. A.
FIGI,
1957,
sinuses
Laryngoscope,
L. D., JR.,
accessory
carcinomas
have
the
best
year survival
in the whole
tumors
F.
and
nasal
histology
per
and
study
uation
locally
the
most
significant
progEarly
well
differentiated
cell
prognosis.
and
LEwIS,
8. LENZ,
M. Symposium.
nose, nasopharynx
12.
of tumor
were
nostic
factors.
clinical
nasal
Surg.,
proce-
to
In the
ordinarily
7.
satis-
tumor.
degree
ofparanasal
E. E.,
cavity.
radiation
and
ex-
plus
disease.
technique
Simple
were
and
nose
149-172..
Irradi-
techniques
external
tumors,
therapy
considered
cinoma
6. LEDERER,
combined
cases).
radium
lesions,
accessible
the
is
was
P. W.,
of
I 293-1301.
nasal
irradiation
and
(14
using
extensive
and
by
surgery
given
the
of
by
cases)
(13
and
was
cancer
initially
surgery
SCANLON,
hemmet
and Otolaryngologic
Karolinska
Sjukhuset.
4cta
of
treated
K. D.,
DEVINE,
Oberkieferhohlen).
370-380.
13,
4. HENDRICK,
J. W. Treatment
of cancer
cavity
and paranasal
sinuses.
Surg.,
Obsi., 1956,
102,
322-330.
5. LARSSON,
L. G., and
MARTENSSON,
SUMMARY
Fifty-seven
(ohne
der malignen
der Nasenne.
Oncologia,
und
163, 617-621.
J. S. Cancer of nasal
cavity
and accessory
sinuses:
report
of management
of 416 patients.
Cancer,
1963,
i#{243},
cases.
cavity
14203
Malignant
tumors
sinuses.
7.A.M.il.,
3. FRAZELL,
E. L., and
treat-
nasal
Institute
Die Strahientherapie
der inneren
Nase
benhohlen
methods.
results
of malignant
reported
by
3-10
35
V.
COCCHI,
Tumoren
Martin9
8
patients
with
by irradiation,
treated
Favorable
ment
were
of
the
REFERENCES
and
out
carcinomas
Badib,
M.D.
Park Memorial
year
survival;
and 4 advanced,
treated
irradiation
with
1-3
year
survival.
In
by
1969
AUGUST,
50 per cent
year survival followed
combined
and surgical treatment.
surgery.
difference
comparable
to our results
cases.
Hendrick4
reported
carcinoma;
4 early,
treated
4-7
D. P. Shedd
and
in the surgical
this
no
be
rate
after
results
results
group,
survival
cure
cent
their
the
radiotherapeutic
results
per
I 8
and
J.
S. S. Kurohara,
141-150.
C. D. Malignant
A.M.A.
Arch.
diseases
Otolaryng.,
of
nose and
1955,
61,